Provider Demographics
NPI:1407142623
Name:BRECK, JOHN D (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:BRECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WARDENBURG WAY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-0001
Mailing Address - Country:US
Mailing Address - Phone:303-492-5101
Mailing Address - Fax:
Practice Address - Street 1:1900 WARDENBURG WAY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309
Practice Address - Country:US
Practice Address - Phone:303-492-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0055792207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine